[Intrathyroid parathyroid adenomas: right and lower].
BACKGROUND
Intrathyroidal parathyroid adenomas (IPA) are a not an uncommon cause of persistent hyperparathyroidism. There is no consensus on their prevalence, embryological origin and position within the thyroid.


METHODS
Retrospective review of prospectively recorded surgical protocols of patients having had parathyroidectomy for primary (n = 437) or secondary (n = 137) hyperparathyroidism by the same surgeon. Cases with IPA were identified and the following data were recorded: age, most probable embryological origin, position within the thyroid (side and height), results of imaging techniques and surgical implications.


RESULTS
Seventeen IPA were detected in 16 patients (6M, 10F, prevalence 3.2%); 9 belonged to IIIP and 8 to IVP. Three lower IPA were supernumerary glands. Eight IPA were included within the right lower thyroid lobe. Twelve IPA (70.6%), were found during the initial parathyroidectomy: 3 were enucleated and 9 were treated with a partial thyroidectomy or hemithyroidectomy. Of the 3 enucleations, 2 had a local benign recurrence due to an incomplete capsule resection. No patients treated with thyroidectomy had a recurrence. The remaining 5 IPA, found in 4 patients, were not identified initially and caused persistence of the disease leading to 5 reinterventions.


CONCLUSIONS
IPA are present in 3% of patients submitted to parathyroidectomy. They predominate in the right thyroid lobe and can be IIIP, IVP and supernumerary. They often cause persistence. Thyroid resection affords the best results since complete enucleation can be difficult and leaving behind a fragment of the IPA results in local recurrence.
Ros
Susana
S
Unidad de Cirugía Endocrina, Hospital Universitario Arnau de Vilanova, Lleida, España. jrros@telefonica.net
Sitges-Serra
Antonio
A
Pereira
José Antonio
JA
Jimeno
Jaime
J
Prieto
Rosa
R
Sancho
Juan José
JJ
Pérez-Ruiz
Luis
L
D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016105:Parathyroidectomy; D012086:Reoperation; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome